Massachusetts General radiologists are rewriting how the specialty screens for breast cancer during the pandemic by implementing a new same-day mammography reading program.
Typically, women are sent home after their exam, with physicians interpreting the images days later before recalling some for additional testing. But this workflow can lead to delayed diagnoses and increase disparities among underserved patient populations, experts wrote Wednesday in the American Journal of Roentgenology.
Following the first COVID-19 shutdown, Mass General relaunched its screening efforts in May 2020 to now offer same-day mammogram reads and any additional imaging all within the same visit. Radiologist and Harvard assistant professor Brian Dontchos, MD, and colleagues see opportunity to expand the service further, with only about 60% of patients receiving same-day diagnoses during the pilot period.
“We believe the practice is sustainable and not limited to only a transient period of lower-than-normal screening volumes,” the study’s authors wrote Sept. 8. “We thus continue to offer this service even as screening volumes have reached pre-pandemic levels. Ultimately, our goal is to offer same-day diagnostic imaging to 100% of patients with abnormal screening mammograms.”
Mass General deployed a dedicated breast imaging specialist to interpret scans on the same day as the exam, while different docs handled ultrasound and other additional exams. Dontchos et al. compared outcomes for women screened between June up until November 2019 (8,200-plus patients) against those imaged the same period in 2020 after the intervention (more than 7,200).
Of those groups, almost 15% received same-day diagnostic imaging (out of 521 abnormal screening exams) compared to nearly 61% (359 abnormalities) after the intervention. (Mass General offered same-day reads before May 2020 by referrer or patient request.) Minority patients also had significantly lower odds of receiving diagnostic imaging on the same day as their mammogram when compared to white women. But there was notable difference between the two after the practice change. And the abnormal interpretation rate was markedly lower following the update (5% vs. 6.3%).
Dontchos and co-authors highlighted other ancillary benefits from same-day reading, including less time spent on scheduling, reduced room cleaning, and less chance of errors. Immediate reads are also recommended by the Society Breast Imaging as a means to work through mammo back logs.
“Operational implementation and sustainability of the program represent important considerations,” the authors advised. “The inherent unpredictability of a screening recall requiring diagnostic imaging leads to workflow challenges that demand creative solutions and buy-in from physicians, technologists, support staff, and operational leadership. Our program did not hire additional staff to support the model, and we believe this program is scalable to smaller and non-academic practices.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.